Provider Demographics
NPI:1265651194
Name:DIENER, ELIZABETH BAKER (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:BAKER
Last Name:DIENER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1501
Mailing Address - Country:US
Mailing Address - Phone:484-772-1111
Mailing Address - Fax:484-772-1112
Practice Address - Street 1:838 PENN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-1108
Practice Address - Country:US
Practice Address - Phone:610-988-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018810340001Medicaid
U88821Medicare UPIN